Assessing the impact of increasing lung screening eligibility by relaxing the maximum years‐since‐quit threshold: A simulation modeling study

Abstract

BackgroundIn 2021, the US Preventive Services Task Force expanded its lung screening recommendation to include persons aged 50–80 years who had ever smoked and had at least 20 pack‐years of exposure and less than 15 years since quitting (YSQ). However, studies have suggested that screening persons who formerly smoked with longer YSQ could be beneficial.MethodsThe authors used two validated lung cancer models to assess the benefits and harms of screening using various YSQ thresholds (10, 15, 20, 25, 30, and no YSQ) and the age at which screening was stopped. The impact of enforcing the YSQ criterion only at entry, but not at exit, also was evaluated. Outcomes included the number of screens, the percentage ever screened, screening benefits (lung cancer deaths averted, life‐years gained), and harms (false‐positive tests, overdiagnosed cases, radiation‐induced lung cancer deaths). Sensitivity analyses were conducted to evaluate the effect of restricting screening to those who had at least 5 years of life expectancy.ResultsAs the YSQ criterion was relaxed, the number of screens and the benefits and harms of screening increased. Raising the age at which to stop screening age resulted in additional benefits but with more overdiagnosis, as expected, because screening among those older than 80 years increased. Limiting screening to those who had at least 5 years of life expectancy would maintain most of the benefits while considerably reducing the harms.ConclusionsExpanding screening to persons who formerly smoked and have greater than 15 YSQ would result in considerable increases in deaths averted and life‐years gained. Although additional harms would occur, these could be moderated by ensuring that screening is restricted to only those with reasonable life expectancy.

Screening for lung cancer: 2023 guideline update from the American Cancer Society

“…34 In addition, a supplemental analysis was commissioned by the GDG School, were invited but were not able to participate) to incorporate various YSQ scenarios, extended screening past age 80 years, and updated radiation risk data. 47 The GDG also benefited from the input of an epidemiologic and modeling analysis conducted by Landy et al…”

“…The results from the Michigan and Erasmus models differ in the absolute magnitude of the estimated outcomes, but the outcome patterns and relative performance of alternative strategies were consistent across the two models. 47 We emphasize results from the Michigan model since screening outcomes (sensitivity and specificity) were based on the American College of Radiology (ACR) Lung Reporting and Data System (Lung-RADS) protocol, and it modeled radiation-induced lung cancer deaths, which we discuss in the section below on Harms associated with LCS. 47 Results from the Erasmus model, which produces outcomes that are more consistent with the NLST, are provided in the supplemental material from the CISNET analysis published online.…”

“…47 We emphasize results from the Michigan model since screening outcomes (sensitivity and specificity) were based on the American College of Radiology (ACR) Lung Reporting and Data System (Lung-RADS) protocol, and it modeled radiation-induced lung cancer deaths, which we discuss in the section below on Harms associated with LCS. 47 Results from the Erasmus model, which produces outcomes that are more consistent with the NLST, are provided in the supplemental material from the CISNET analysis published online. 47 Modeling results for the USPSTF 2021 recommended strategy (50-80-20-15) and the 2023 ACS guideline update with identical parameters were similar (Table 3, rows 1 and 2) but not directly comparable because results from the 2021 CISNET modeling were presented as mean estimates across the four models, 46…”

“…46 In the CISNET modeling done for this guideline update, which eliminates YSQ15 as an exclusion criterion, the estimated overdiagnosis rate was similar to that in the Michigan model alone (4.8% over a lifetime of screening). 47 However, when individuals undergoing screening had at least 5 years' life expectancy (Table 4), the estimated overdiagnosis rate was 52% lower (2.3% vs. 4.8%), emphasizing the importance of prioritizing an assessment of life-limiting comorbidity and longevity before offering screening.…”

Time to quit using quit time as a lung cancer screening eligibility criterion

“…In their analysis of the benefits and harms of LCS with varying years since quit, in this issue of Cancer, Meza and colleagues 7 conclude that "Expanding screening to persons who formerly smoked with >15 years since quitting would result in considerable increases in deaths averted and life-years gained; and, although additional harms would occur, these could be moderated by ensuring screening is restricted to only those with reasonable life expectancy." In their study, Meza et The first option is to extend the quit-years duration.…”